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. 2021 Oct 18;106(1):257-267.
doi: 10.4269/ajtmh.21-0615.

The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia

Kris Salaveria  1 , Simon Smith  2 , Yu-Hsuan Liu  1 , Richard Bagshaw  2 , Markus Ott  1 , Alexandra Stewart  3 , Matthew Law  4 , Angus Carter  1   5 , Josh Hanson  2   4
Affiliations

The Applicability of Commonly Used Severity of Illness Scores to Tropical Infections in Australia

Kris Salaveria et al. Am J Trop Med Hyg. .

Abstract

Many patients with leptospirosis, melioidosis, and rickettsial infection require intensive care unit (ICU) admission in tropical Australia every year. The multi-organ dysfunction associated with these infections results in significantly elevated severity of illness (SOI) scores. However, the accuracy of these SOI scores in predicting death from these tropical infections is incompletely defined. This retrospective study was performed at Cairns Hospital, a tertiary-referral hospital in tropical Australia. All patients admitted to ICU with laboratory-confirmed leptospirosis, melioidosis, and rickettsial disease between January 1, 1999 and June 30, 2020, were eligible for the study. The ability of Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, Simplified Acute Physiology Scores (SAPS) II, and Sequential Organ Failure Assessment (SOFA) scores to predict death before ICU discharge was evaluated. Overall, 18 (12.1%) of the 149 included patients died: 15/74 (20.3%) with melioidosis, 2/54 (3.7%) with leptospirosis and 1/21 (4.8%) with rickettsial disease. However, the APACHE II, APACHE III, SAPS II, and SOFA scores significantly overestimated the case-fatality rate of all the infections; the disparity between the predicted and observed mortality was most marked in the cases of leptospirosis and rickettsial disease. Commonly used SOI scores significantly overestimate the case-fatality rate of melioidosis, leptospirosis, and rickettsial infections in Australian ICU patients. This may be at least partly explained by the unique pathophysiology of these infections, particularly leptospirosis and rickettsial disease. However, SOI scores may still be useful in facilitating the comparison of disease severity in clinical trials that examine patients with these pathogens.

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Figures

Figure 1.
Figure 1.
Number of patients admitted to Cairns ICU with melioidosis (A), leptospirosis (B) or rickettsial disease (C) between January 1999 and June 2020 and their outcomes. This figure appears in color at www.ajtmh.org.
Figure 2.
Figure 2.
APACHE II scores' prediction of case-fatality rate compared with the observed case-fatality rate in patients admitted to Cairns Hospital ICU with melioidosis (A), leptospirosis (B) and rickettsial disease (C) between January 1999 and June 2020. This figure appears in color at www.ajtmh.org.
Figure 3.
Figure 3.
APACHE III scores' prediction of case-fatality rate compared with the observed case-fatality rate in patients admitted to Cairns Hospital ICU with melioidosis (A), leptospirosis (B) and rickettsial disease (C) between January 1999 and June 2020. This figure appears in color at www.ajtmh.org.
Figure 4.
Figure 4.
SAPS II scores' prediction of case-fatality rate compared with the observed case-fatality rate in patients admitted to Cairns Hospital ICU with melioidosis (A), leptospirosis (B) and rickettsial disease (C) between January 1999 and June 2020. This figure appears in color at www.ajtmh.org.
Figure 5.
Figure 5.
SOFA scores' prediction of case-fatality rate compared with the observed case-fatality rate in patients admitted to Cairns Hospital ICU with melioidosis (A), leptospirosis (B) and rickettsial disease (C) between January 1999 and June 2020. This figure appears in color at www.ajtmh.org.
Figure 6.
Figure 6.
APACHE III scores' prediction of case-fatality rate compared with the observed case-fatality rate in patients admitted to Cairns Hospital ICU with leptospirosis, melioidosis and rickettsial disease (A), leptospirosis and rickettsial disease alone (B) and other causes of sepsis (C) between January 1999 and June 2020. This figure appears in color at www.ajtmh.org.
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